Identity Resolution Daily

By the Infoglide Software Team

CNN: Lottery officials: Rightful winners of ‘03 jackpot getting paid

“The buyer redeemed the ticket later at the outlet in Burlington and wasn’t told that he won a free ticket, investigators determined, according to the CBC. That ticket went on to win a $12.5 million jackpot. It was claimed by Kathleen Chung, sister and daughter of men who worked at the outlet.”

O’Reilly Radar: Will data warehousing survive the advent of big data?

“The current hype around ‘big data‘ has caused some analysts and vendors to declare the death of data warehousing, and in some cases, the demise even of the relational database. A prerequisite to discussing these claims is to understand and clearly define the term ‘big data.’ However, it’s a fairly nebulous concept.”

Healthlaw Insights: Whistleblower Suits are Rewarding and So is Fraud Recovery

“In addition, the Medicare Fraud Strike Force has been extended to seven cities. Using advanced data analysis techniques to identify high billing levels in healthcare fraud hot spots, the interagency teams can target emerging or migrating schemes along with chronic fraud by criminals masquerading as healthcare providers or suppliers.”

ClaimsJournal.com: Florida Businessman Charged with Workers’ Compensation Fraud

“Florida CFO Jeff Atwater announced the arrest of David Rodriguez-Socarras, who officials allege used a ’shell’ company and fictitious name in order to cash nearly $3 million in payroll checks through a money service business to avoid workers’ compensation premiums and payroll taxes.”

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By the Infoglide Team

BND.com: Insurance fraud investigators begin probe into workers’ comp claims at Menard

“A total of 389 guards and other workers have filed more than 500 claims, including about 290 still pending. About 230 of these claimed injury for the underlying cause of ‘repetitive trauma,’ including carpal tunnel syndrome, an injury of the wrist. The prison employs about 760 workers, of which 567 are guards. ‘The Department of Insurance is investigating recent questions raised in connection with workers’ compensation claims filed against the state of Illinois at the Menard Correctional Center,’ department spokesman Louis Pukelis said Tuesday in a written statement.”

HSToday: Fusion Centers: Tough Tightrope 

“As states and localities have put up fusion centers designed precisely to overcome this, however, they’ve had to face a different challenge: ensuring not only the quantity but the quality of information they collect and report. In candid conversations with Homeland Security Today, leading privacy advocates, scholars and state law enforcement and federal officials addressed some of the key facets of this challenge, as well as steps that can be taken to ensure that fusion centers live up to their full potential as a counterterrorism tool.”

StarNewsOnline: North Carolina collects big from Medicaid fraudsters

“North Carolina’s Medicaid fraud investigators pulled in millions last year through dozens of cases of fraud and patient abuse, the state’s attorney general’s office reported Monday. The office’s Medicaid Investigations Unit prosecuted 22 criminal convictions and 18 civil settlements, recovering $53.5 million, during the federal fiscal year that ended Sept. 30, according to a press release from N.C. Attorney General Roy Cooper.”

ReadWriteWeb: What Cloud Computing Means For Small Businesses

“Needless to say, it’s a huge deal. Gartner recently put cloud computing at the top of its list of top strategic technologies for 2011 and it’s far from the only expert extolling the glory of the Web-hosted software and infrastructure. For small businesses, the significance of this primarily comes down to cost. In many cases, using cloud-based infrastructure is cheaper than running and maintaining one’s own physical servers.”

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[Post from Infoglide] Secure Flight Reaches Critical Milestone

“On November 1, the Secure Flight program achieved a key goal as described on the Transportation Security Administration (TSA) web site: Secure Flight, the Transportation Security Administration’s (TSA) behind-the-scenes watch list matching program, fulfills a key recommendation of the 9/11 Commission by assuming responsibility of watch list matching from individual airlines. By establishing a consistent watch list matching system, Secure Flight enhances aviation security and more effectively facilitates air travel for passengers.”

ZDNet: Saturday Post: How the cloud will bring the future to the global masses

“With a simple text message system you can bring the power of a supercomputer to the cheapest and simplest mobile phones via cloud computing. For many important applications there is no need to place supercomputing power in the device itself. Simple cell phones can act as smart phones today, thanks to the cloud. That’s an amazing technological advance.”

Ventura County Star: Simi hospital pays $5.15 million to settle Medicare case

“The hospital, according to Field, allegedly paid a doctor $12,000 a month in Medicare money to serve as a medical director and to get patients admitted into a nonexistent program for women with post-traumatic stress disorder. Field also alleged the hospital billed Medicare for services to psychiatric patients without the doctor certification statements required by the government. ‘In essence it appeared that what the hospital was doing was obtaining reimbursement from the federal government for medically unnecessary psychiatric services,’ Assistant U.S. Attorney Lisa Palombo said.”

Orange County Register: Roofing contractor gets 10 years for workers’ comp fraud scheme

“‘He has taken no responsibility for his conduct,” Kamiabipour said. ‘When he gets out, he’ll do it again.’ Petronella’s attorney, Tom Dunn, said the sentence was fair, though he would have liked to see his client get less time. Dunn also commended the judge for his “thoughtful and sound” decision on restitution. State officials and prosecutors say the couple operated a $38 million workers’ compensation insurance-fraud scheme.”

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[Post from Infoglide] Preventable Nightmares?

“Every father’s nightmare happened in North Carolina this week. A young woman apparently left a bar voluntarily with a man she met there, and she was subsequently found murdered. The apparent murderer arrested in Niagara Falls had a criminal record that included sexual abuse and was on probation in North Carolina. Could this tragedy have been prevented?”

mydesert.com: Palm Desert store the good guys in lottery fraud investigation

“In the sting, investigators presented lottery retailers with winning lottery tickets for large dollar amounts and tested whether the retailer would properly inform them of their winnings. The Jensen’s on Cook Street was the only retailer who informed the undercover agent of his winnings.”

Fort Worth Star-Telegram: Airline passengers to face new security rules

“American spokesman Billy Sanez said that for tickets purchased before Sept. 15 for travel dates Nov. 1 and later, the Secure Flight data was requested but not required. The airline’s reservation system now requires the data for travel after Nov. 1. ‘Now, you won’t be able to get a ticket if you don’t give us that information,’ Sanez said. He said it must be provided no matter where the ticket is purchased: online, through a travel agency or at the airport.”

DOJ: Lowell Couple Pleads Guilty in Under-the-Table Payroll Scheme

“The defendants concealed the true size of their payroll from the IRS, and from their workers compensation insurer, in order to reduce their employer payroll taxes (FICA) and their workers compensation insurance payments. They did this by paying their employees in cash each week and hiding any record of the payments. Even though they retained a payroll service, they routinely told the service that C&A had no work and therefore no employees. Relying on this misrepresentation, the payroll service filed over 20 quarterly payroll tax returns on behalf of C&A that reported no payroll.”

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[Post from Infoglide] Reference Linking Methods - Part 4

“In the direct matching, transitive linking, and association analysis methods discussed in previous posts, the evidence for establishing a link comes from the references themselves, either as attribute values or relationships with other references.  A link created in this way is also called an inferred link. But in almost any ER context, some pairs of equivalent references (i.e. that refer to the same entity) will have insufficient evidence available in the references themselves to make that determination, thereby leaving them as unlinked false negatives.”

Liliendahl on Data Quality: Out of Facebook

“Doing ‘Social Master Data Management’ will become an integrated part of customer master data management offering both opportunities for approaching a ’single version of the truth’ and some challenges in doing so. Of course privacy is a big issue.”

CRN: SMB Cloud Spending To Approach $100 Billion By 2014

“Total cloud-related information and communications technology spending among SMBs globally surpassed $52 billion in 2009, representing just 6 percent of total worldwide SMB ICT spending. But AMI predicts that that will nearly double over a five-year period.”

Media Newswire: Owner of illegal money transmitting business sentenced to 2 years in prison, ordered to forfeit $690K

“According to court documents, between Jan. 1, 2004 and Dec. 31, 2008, Lemine, owner of Sorrento Grocery in Sorrento, Fla., cashed more than $4 million in checks from a local construction company in return for a fee of between 1 and 1.5 percent of the checks’ face value. He did so knowing that the owners of the construction company were attempting by cashing the checks through the grocery to conceal their employment of illegal aliens, avoid paying worker’s compensation and employment taxes, and hide income from state and federal tax officials.”

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[Post from Infoglide] Best Practices Just Got Better

“On the heels of the very successful Association of Certified Fraud Examiners (ACFE) conference last month comes an industry event which represents investigators of financial crimes and fraud.  The International Association of Financial Crimes Investigators (IAFCI) meets in Washington, DC next week  with an agenda that is chock full of sessions involving discussions of best practices for solving and preventing financial crimes.”

Insurance & Technology: Analytics Improving Insurers’ Claims Fraud Detection Efforts

“In a recent report, Light noted that the key to successful fraud mitigation with technology is applying a combination of several methods - including the typical red flag approach, predictive modeling, neural networks, profiling, claims databases and identity matching - to ‘maximize the identification of true positive fraudulent claims and of true negative fraudulent claims.’”

Paul Davis on Crime: Connecting the Dots at the Local Level: Centers Make Homeland Security a State, City, and Local Affair

“Robert Riegle from the Department of Homeland Security describes fusion centers as force multipliers. ‘They leverage financial resources and the expertise of numerous public safety partners to increase information awareness and help our law enforcement agencies more effectively protect our communities.’”

The Blog: Judy Schurke, Director, Department of Labor & Industries

“L&I works extensively with state and federal law enforcement, and other regulatory agencies to detect and prosecute individuals committing workers’ comp fraud, contractors failing to register with the state, and businesses that wrongly classify workers to cheat on insurance premiums. Some investigations lead to criminal prosecution. People tend to think fraud only involves workers cheating the workers’ comp system. But in reality, millions of dollars are lost when employers, medical providers and contractors commit fraud.”

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By the Infoglide Team

All247News.com: Medicare Fraud: Updates on Government’s Efforts to Recover Money Lost to Scam Artists

“Medicare fraud and billing errors costs the government more than $36 billion last year, the Economist noted. The modus operandi involves a “care-provider” billing Medicare for non-existent or unnecessary services. These services and items include: HIV/AIDS medicines and therapy; medical equipment such as wheelchairs to neck and knee braces, as well as home health care, physical and occupational therapy and mental-health services.”

CBCnews: Crime proceeds crackdown looms

“Another method used by organized crime is to pay a 10 per cent premium for winning lottery tickets or to buy jewelry in Canada worth tens of thousands of dollars and sell it in the U.S., achieving money laundering and foreign exchange conversion at the same time.”

San Antonio Express-News: Police ‘fusion center’ on the way for S.A.

“Each center can have an individual purpose, McManus said. The South Texas center will have two branches: one working on homeland security, bolstered by a new San Antonio Police Department Terrorism Criminal Intelligence Division, the other a 24-hour tactical operations center for ‘all crimes and all hazards as they occur in San Antonio and the region.’”

Washington State Wire: Will a ‘September Surprise’ Derail Workers’ Comp Initiative?

“Schurke said a fraud-prevention effort launched in 2005 has increased collections dramatically. Collections due to L&I investigations have increased 40 percent, to $770 million. The department has invested in advanced computer technology that should make it easier to track down employers who are not reporting fully. The systems will make it possible to compare 20 state and federal databases, including the IRS.”

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[Post from Infoglide] The Not So Great Fortune 500 Enterprise

“Of the various types of crime involving fraud, individual cases of people scamming workers’ compensation garner the most publicity. The stories typically read like this: ‘Joe Blow was drawing workers’ comp while working as a personal trainer, and after he was caught on video, he had to pay back $9000 and received a five-year suspended jail sentence.’ While the human interest aspect of these stories, especially those including video of an injured worker involved in heavy physical activity, capture the most public attention, more organized activities impact the U.S. economy much more negatively.”

Cato Unbound: The Sky Isn’t Falling

“But a careful observer can detect the outlines of other intelligence successes based on surveillance in recent events. When David Headley was arrested for allegedly seeking to commit terrorist acts in Denmark, news reports suggested that one of the key factors in his identification was his pattern of travel to the Middle East and his efforts to conceal those trips from the government. Review of his travel both provided the trigger to ask questions and the factual cross-check on the veracity of his answers. Likewise, when Najibullah al-Zasi was arrested, one factor that was publicly disclosed as a ground for suspicion was surveillance of his travel to Pakistan.”

CIO: Healthcare Data Quality: Providing Better Patient Care

“Three things immediately jump to mind. The first is something very basic, but important: being able to identify a patient. Think of how many different ways might a patient’s name appear in a physician’s database. From misspellings to inconsistent middle name initial usage, multiple combinations of a name can lead to confusion. If healthcare providers don’t know who their patients are, how can they provide them with quality service?”

GovMonitor: Washington Cracks Down On Workers Compensation Fraud

“‘For every dollar Labor and Industries spends to combat fraud, we’ve seen an eight dollar return,’ Gregoire said. ‘By preventing and punishing fraud, we protect workers and honest businesses from unfair competition. Fraud in the workers’ compensation system hurts our economy – honest businesses are undercut by those that don’t fairly participate in the system and workers pay more than they should when others claim more benefits than they deserve.’”

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By Mike Betron, Infoglide Software Director of Marketing

Of the various types of crime involving fraud, individual cases of people scamming workers’ compensation garner the most publicity. The stories typically read like this: “Joe Blow was drawing workers’ comp while working as a personal trainer, and after he was caught on video, he had to pay back $9000 and received a five-year suspended jail sentence.” While the human interest aspect of these stories, especially those including video of an injured worker involved in heavy physical activity, capture the most public attention, more organized activities impact the U.S. economy much more negatively.

The National Insurance Crime Bureau (NICB) recently released a comparison of reported instances of suspected insurance fraud for the first half of 2010 versus the first half of 2009. An article in the Charleston Post and Courier observed that “while there’s no definitive study to link the economic recession to insurance fraud, certain types of claims are rising as other forms of income, from stock dividends to paychecks, are drying up. And the trend is creating more work for the parties who work together to fight insurance fraud.”

In highlighting the cost of fraud three years ago in IdentityResolutionDaily, we tagged it as a tax on all of us. The Post and Courier article said that “those types of insurance cost more than $85 billion a year, spreading an extra cost of $1,030 per year to the average household.  ‘If insurance fraud was a business, it would be a top Fortune 500 company,” the A.G.’s website states.’”

The bad news is that this “Fortune 500” fraud enterprise is big and growing; the good news is that the more organized it gets, the more detectable it becomes using entity resolution.

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By the Infoglide Team

wkyc.com: Ravenna: Police arrest store owner in Ohio Lottery claim investigation

“Lottery officials say the Lottery’s Office of Security is a statewide program developed by the Lottery and executed in cooperation with local law enforcement authorities. It is designed to protect Lottery customers by ensuring that winning tickets are not wrongfully claimed by retailers or their employees without payment to the customers. The program, a sting operation in which Lottery investigators posing as customers present tickets to be checked, is ongoing and is expected to yield additional arrests.”

insurancenewsnet.com: California Announces $29.8 Million in Fraud-Fighting Grants

“U.S. property/casualty insurer financial impairments have more than tripled since 2007, the last full year before the current recession, rising to 18 in 2009, up from 16 in 2008 and from five in 2007, according to a recent A.M. Best special report (BestWire, June 22, 2010). A.M. Best has found over the past 41 years of this study that the financial impairment frequency typically rises during and shortly after periods of economic and financial market stress.”

InvestmentNews: Who’s supposed to watch what?

“Updated anti-money-laundering regulations, pending trade-reporting rules and new custody rules for advisers are some of the initiatives that are raising questions about the division of compliance responsibilities. ‘Some of those lines [of responsibility have] blurred as regulators focus on anti-money-laundering,’ said Jeff Horowitz, director of compliance at Pershing. ‘Anti-money-laundering has morphed into anything to do with fraud, manipulation or low-priced securities.’”

iContactCommunity: Workers Compensation Budget Impact

“A recent article written by IAIABC Executive Director Greg Krohm does a great job of analyzing the effects that the Patient Protect and Affordable Health Care Act of 2010 (aka Obamacare) and the American Recovery and Reinvestment Act of 2009 are expected to have on the cost and administration of workers’ compensation programs.”

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